title: Surgical management of silicone mastitis: case series and review of the literature.
abstract: BACKGROUND
  Free silicone injection for breast augmentation, which became widespread in the 1960s and continues illicitly to this day, has well-known adverse effects. In this retrospective chart review of 14 patients treated for silicone mastitis from 1990 to 2002, we present our experience with the surgical management of patients with silicone mastitis.
  
  
  METHODS
  All the patients were women, ranging in age from 49 to 76 years old (mean age = 58.8). Patients presented to us a mean of 29.9 years after their free silicone breast injection. Treatment modalities were analyzed, and, specifically, methods of breast reconstruction involving autologous tissue transfers, implants, or a combination were evaluated.
  
  
  RESULTS
  The majority of patients (12 of 14) required mastectomies for extensive silicone-infiltrated tissues. The remaining two patients had focal areas of disease and were successfully treated with excision and local breast parenchyma flaps. Autologous reconstruction was performed with a total of 20 flaps, including 12 free transverse rectus abdominis myocutaneous flaps, 4 free superior gluteal artery perforator (SGAP) flaps, and 4 pedicled latissimus dorsi (LD) flaps. Two patients had bilateral implant-based breast reconstruction.
  
  
  CONCLUSIONS
  A variety of reconstructive options are available for patients presenting with silicone mastitis. Once an appropriate breast cancer workup has been performed, the surgical goal is to excise as much of the silicone-infiltrated tissues as possible before reconstruction. To our knowledge, this is the first reported series that incorporates the use of SGAP and LD flaps as a means of autologous tissue reconstruction for silicone-infiltrated breasts.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Division of Plastic Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304-5715, USA. anthony.echo.md@gmail.com
authors.forename: Anthony
authors.initials: A
authors.lastname: Echo
authors.forename: Leo R
authors.initials: LR
authors.lastname: Otake
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Kraneburg
authors.forename: Nikhil
authors.initials: N
authors.lastname: Agrawal
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Da Lio
authors.forename: William W
authors.initials: WW
authors.lastname: Shaw
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
mesh_terms: D000368:Aged; D019928:Breast Implantation; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects; D008408:Mastectomy; D008413:Mastitis / Q000139:chemically induced / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012828:Silicones / Q000009:adverse effects*
chemical_list: D012828:Silicones; C078211:polymethylsiloxane